| NPI | 1447350970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011776-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 006621) |
| 111N00000X Chiropractor (Licence: TX 7130) | |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2010-06-18 |